# CUSTOM HEALTHCARE COMPOUNDING PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467794552
- **Authorized official:** ANHVUONG LY (PHARMACIST IN CHARGE)
- **Authorized official phone:** (925) 330-8975

## Contact information

- **Practice address:** 24022 CALLE DE LA PLATA STE 510, LAGUNA HILLS, CA 92653-3631
- **Practice address phone:** (949) 595-2273
- **Practice address fax:** (949) 595-2275
- **Mailing address:** 24022 CALLE DE LA PLATA STE 510, LAGUNA HILLS, CA 92653-3631
- **Mailing address phone:** (949) 595-2273
- **Mailing address fax:** (949) 595-2275

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 51905 | CA | Yes |

## Other

- **Enumeration date:** 03/27/2013
- **Last updated:** 09/28/2015